Click here for a downloadable Frequently Asked Questions
document.
Click here for Medicaid Reimbursement Information.
Click here for Medicaid
Fraud Information.
Click here
for Billing for Leaves of Absence.
Click here for Occupancy Form Year 08-09.
Click here for
Occupancy Form Year 07-08.
Click here for Forms & Certificate Clarification:
Timely Waiver
Form
Administrative Review Form
Is your INITIAL Batch/Claim being submitted within 60 days of all dates of
service listed on the claim?
Is the RE-SUBMISSION of your Batch/Claim being submitted within 90 days of
all dates of service listed on the claim?
If you are disputing a Batch/Claim have you submitted the Appeal Letter
and necessary documentation for review?
(Remember you must submit within 90-days. Submissions that are submitted
beyond the 90th day are past the claim filing limit and appeal process).
Is the authorization valid, and are the units and dollar amount correct
according to the services being billed?
Do you have documentation to support the DATES OF SERVICE being
billed?
Are the services being billed according to your specific contact & Fee
Screen.
Are your “CURRENT” contract guidelines being followed, so that you are in
compliance with Synergy and the DWCCMHA?
- Do you have a copy of your signed contract or addendum letter in
file?
- Is your License current?
- Do you have a paid Liability Insurance Policy?
- Is the Liability Certificate submitted to Synergy active within the
contract year?
- Have you submitted your current FEP / Fair Employment Practice
Certificate?
- If applicable, have you submitted the Leave of Absence (LOA ) 3806 form
when submitting your claims for payment?
- Does Synergy have your most current demographic information i.e. correct
addresses, phone numbers, fax numbers, e-mail addresses?
Once you have entered a “CLEAN” claim into the S.T.A.R.S. system, and it
has been adjudicated and approved for payment, a check will be issued to the
provider within 30 days.
The Finance Department will select batch/batches that have been
adjudicated and are approved for payment. The enhancement to the system will now
identify this batch as “PENDING PAYMENT”. The batches will not
go into the “PAID” status until the check information has been
uploaded into STEP (4) on the adjudication side. The Finance
Department will then upload a file containing the check date and check number of
paid claims. The claims will automatically get updated to reflect the check
information. The STARS system will then reflect your batch as
“PAID”. The provider may than print their Remittance Advice
& EOB.
This is the area that the Finance Department will apply debits/credits to
the provider balance when applicable. This will occur when Synergy has paid a
provider twice in error or an underpayment has occurred. The outstanding balance
will be applied to the payment amount of the provider’s claim/batch that has
been adjudicated and is awaiting payment. Your batch will identify this debit or
credit as a “
Provider Adjudication Debit” or
“Provider
Adjudication Credit” on the payment line of the claim. Also, the
Adjudication Report & Remittance Advice will have a line identified as
“No Adjustments Provider is in Balance” or
“Provider
Adjudication Debit” or
“Provider Adjudication Credit”.
If you have reviewed your claim, answered all of the above questions,
and are still having difficulty, please e-mail Debra Schuchert (
dschuchert@synergypartnersllc.com)
with your claim/payment issues.
